US · guidance
CMS Pub. 100-03, ch. 1, § 80.11
Vitrectomy
CIM - 35-16
Vitrectomy may be considered reasonable and necessary for the following conditions:
vitreous loss incident to cataract surgery, vitreous opacities due to vitreous hemorrhage or
other causes, retinal detachments secondary to vitreous strands, proliferative retinopathy,
and vitreous retraction. See chapter 23 of the Medicare Claims Processing Manual for
how to determine payment for physician vitrectomy services and the Medicare Claims
Processing Manual, Chapter 14, “Ambulatory Surgical Centers,” §40, for how to
determine payment for ASC facility vitrectomy services. Also, see the Medicare Claims
Processing Manual, Chapter 23, “Fee Schedule Administration and Coding
Requirements,” §20.9, to identify when, for Medicare payment purposes, certain
vitrectomy codes are included in other codes or when codes for other services include
vitrectomy codes.
History
(Rev. 48, Issued: 03-17-06; Effective/Implementation Dates: 06-19-06)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
122bec9910eee1a354d6fd3d8096c236be4cc7f5f1581ca90082526d6ca18655
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